Have you ever served in the armed forces or are a dependant of someone serving?
*Have you ever served in the armed forces or are a dependant of someone serving?

Please provide a brief description of your main problems, including details of any previous or current mental health problems (including any support you have had in the past)
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Please provide a short description of the main problem(s) you would like support with, to give us a brief understanding of why would like like to seek our support. This can include a type of therapy you are interested in, the problem you would like support with or the reason you are referring yourself to the service e.g. who suggested it. This will be discussed in more detail when you have an assessment in the service so it does not have to be in-depth.

What are your expectations from this referral? Do you have a goal or aim?
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Please confirm that you have understood the following policies, regarding appointments, prior to submitting your online referral:
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Commitment to therapy is essential, to ensure that it is successful for you. Our service policy on attendance is as follows: You are expected to attend all of your appointments. If you do not attend an appointment and you have not informed us in advance, you will be discharged from the service (unless there are exceptional circumstances). In addition to this, if you cancel an appointment with less than 24 hours notice, this will be counted as one of your treatment sessions, as we will be unable to offer the time to another patient. If you cancel 2 appointments, or if you are regularly rearranging appointments, you may also be discharged from the service.

Please be aware our service is open Monday to Friday between 9 and 5.30pm. Where possible we will try our best to accommodate your appointment time preferences. However, in line with NHS referral to treatment guidelines we have to offer you the first available appointment. Unfortunately if you decline more than 1 offered appointment you are not considered to be “fit, willing and able to access treatment” and therefore will be discharged.